Homestead_Tichenor (2).��CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION FORM
Shx Porm Sa]] (R15 / Sta) HC10
�I' Resmh M �y iM DeParimmt d Lnral Govemment Fvanre y
INSTRUCTlONS: See raverse side lar fdirg ins,Y�mnbns. gn
NOTE: Teleplrone, Sma'al Secunry, dlivels license, stafe idenG:�obn aritl lede2l itlentifrcafion numbers ara con;ltlenGa/ u�G 6V.1
�(we) �[�,/�d(L.G�� fT //(�KLF-U/U certify that I(we) occtipi 1'� r)§p
place of residence or am (are) buying the following descnbed real property under conVacl for which a Homes;ea�rtj�x 65
Deduction is hereby Gaimed on the date this applica:ion is si9ned, (date olsgnatu2). I(VJe):
�O.m. ❑ Am (are) buying under recorded contract. �(n�'p� /� —
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporetion. ��Q��, ^ni'�'Y�TM
❑ Have a benefidal interest in the ir�st or ihe right ro ocwpy Ne property under the terms of a qJane ofYd11ts7a
❑ Am (are) the shareholder, partner, or member of the entity that owns the pmperty.
01 Wimar:t's spouse (las fiva d'gasl
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ParQl r.:mEer /f Lcgal Cesaiaion ( ls pro .ry in ques:on
_� �O - � eal ptoperty ❑ PmuaDy as.sesuC rtpbie Mrtp (lt 6t. t-n
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a�ry poraon of ine resMe�eial vu�ture w Ine lana `wt exceeavq one (t� ace Nat' .-reOia'sy s tlut Y.�ucure s useE b yoEUZ'umne, tlesm�e Ne use anC pomm�
���ry��,a��� �/,a�� G�� � o�°f % :
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5a:e. Courcy. aw ivxnsniv ' Is tlaimant rdra':uig a �wnestead?
❑ Yes I] No II
S9�'x�rt of avr ��/J /�
I hereby certrfy Ne above siatemenis are Vue, cortect, aM comple.e. �� �"L�(/�
FECress W mraa (numDei erM s�ue�et r9y.5ate. erM ZIPmCe) � nrateE Mmes[eaG, d anY (numDe� aM sveal tiy.5ate[. ,e�rpLP
�� � � f�f � ,/%�.�K� L./��i .E� � �. /�i/%f1-[�L�i�% Ll�% U!� �!�
Lantl no[ asceeding one (1) acre immadlatety
surrounAinA resiAentlal ImO�ovemanb
Oth¢r IanE
Total IanE Qine 1 plus lina �
Rasitlentlal improvemen6 or Dwelling
Annuaity Assessed MoElle /
Manufrcturetl Homa Gange
ONer improvemen6
Toql improv¢ments Qino d Nmugh line 6;
Topl valua (line ] pl�s line n
I hereby caNry Ne above is Vue, correc4
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(B)
5gre1ro of Aszeuw
20 _ pay 20 _ Lesser af 60% of Ne assessed value of the homes:eatl or Sa5,000 �
AbN+ithsta�Mirg any oiherpmvision, (he wm of the detluclions pmvitled in IC 64.742 to a mobile homa 5
Nat is rrof essessed as real pmPerty or ro a manufarlumd home lhaf is rrot assessed as �eelpmperty may �i
not ezceetl one-ha7(72) ot Me assesse0 value o7Ne mod7e hwne wmanu(artured home.
Sg:a^vre otAUaew I Da's v9^� (men. aaY.Ye�
DISTRIBUTION: Omiul - CoumyAUE:.nr, F�o-SampeC Copy- Tazpayer
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